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MAOI or ECT? Patient Preference and Joint Decision-Making in Treatment-Resistant Depression

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The literature concurs that the classic monoamine oxidase inhibitors (MAOIs) and electroconvulsive therapy (ECT) are both vital treatment options for ‘treatment-resistant’ depression (TRD)—but ECT is commonly presented as an option and MAOIs are not. This is a significant deficit in current psychiatric practice and constitutes a violation of the joint decision-making paradigm. The patient cannot choose between options the physician does not offer, thereby precluding meaningful patient participation in treatment selection. We emphasize the favorable side-effect profile of MAOIs when contrasted with ECT and argue that MAOI treatment should generally be considered as either a prior or alternative step in the treatment protocol for TRD. This is in line with the recommendations in the Dutch stepped- and shared-care approach to TRD, as expressed in their Standard of Care for Depressive Disorders. We conclude this line of reasoning by stating that the physician is morally obliged to both improve his/her understanding of the merits of MAOI treatment, and to pass this knowledge on to his/her patients. Only then is informed choice possible.

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The authors wish to thank Dr. Natalie Rasgon for reviewing their manuscript.

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Correspondence to Vincent Van den Eynde LL.M..

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VVdE is an external research consultant for and receives or has received consulting fees from PsychoTropical Research, NeuraWell Therapeutics, Aristo Pharma GmbH; he has stock options in NeuraWell Therapeutics.

PKG has equity interests in and is on the advisory board of NeuraWell Therapeutics, the company that has the patent for a modified form of tranylcypromine.

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Van den Eynde, V., Gillman, P.K. MAOI or ECT? Patient Preference and Joint Decision-Making in Treatment-Resistant Depression. Curr Treat Options Psych 9, 419–422 (2022).

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